Cancer Metastases To The Hand: A Systematic Review And Meta-Analysis
Todd Dow, MD1; Caitlin Davis, B.Sc1; Rawan ElAbd, MD2; Donald H. Lalonde, MD3; Jason Williams, MD, FRCSC1
1Dalhousie University, Halifax, NS, Canada; 2Al-Amiri Hospital, Kuwait City, Kuwait; 3Dalhousie University, Saint John, NB, Canada
INTRODUCTION: Metastatic lesions to the hand or wrist are rare and can mimic inflammatory and benign processes such as gout and infections. This often leads to misdiagnosis, underreporting, and delays in treatment. The purpose of this study is to examine all known cases of acrometastasis to the hand or wrist available in the literature and to analyze demographic trends, metastasis characteristics and clinical course, and provide recommendations for management.
MATERIALS AND METHODS: An online systematic review of MEDLINE, EMBASE, PubMed and The Cochrane Library from inception to January 7, 2022 was completed. Studies outlining the care of a patient with acrometastases of the hand were included. Data extracted included age, sex, site of primary tumour and metastasis, presence of other metastases, time from primary diagnosis to acrometastasis diagnosis, misdiagnosis, treatment, and survival.
RESULTS: Between 1889 and present 871 lesions were described in 676 patients who met the inclusion criteria. There was no predilection for hand dominance or site of previous trauma. The mean age among patients was 59.5 (1.5-91) years and male sex was more common (64.6%). The most common primary cancer source was the lung (39.2%), followed by the kidney (10.8%). The distal phalanx was the most frequently cited tumour location (33.7%). Mean survival following diagnosis of acrometastasis was 6.3 months (0.25-50) +/- 11.5 months.
CONCLUSION: Acrometastasis remains an uncommon presentation of metastatic disease with poor prognosis. Treatment currently focuses on pain management and optimizing functional outcomes. Our review led to the development of eight treatment recommendations when managing these patients.
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